THE old notion that children are best seen and not heard is officially out of fashion — unofficially, however, many of us still think that a quiet child is a good one. Yet while quiet may be deemed good, mute is deeply unsettling. As the mother a child with selective mutism (SM) explains: “People thought he was traumatised or rude — or a bit weird.”
SM is a symptom of social anxiety, affecting mostly children of primary-school age. A child who is selectively mute is unable to speak to people in specific social situations, but will speak normally at home to parents or siblings. To the untrained eye, it might seem like wilfulness or, at worst, a sign of deep trauma. These assumptions are, however, old-fashioned, unhelpful and, more to the point, incorrect. In the past ten years experts have come to see SM as a manifestation of anxiety, not a behaviour the child “chooses” to have. This change of thinking has been reflected in the replacement of the term “elective” with “selective”, which better describes the nature of the condition — that the child can speak to some people some of the time.
The estimates of just how many have the condition range from one in 500 to about seven in 1,000 children. The problem is that SM is still not well known enough, even among professionals who work with children, for parents to be able to gain access to the right kind of help.
When Eddi Edem first expressed concerns that her daughter Lauren, then 2, was fluent at home, but unusually mute outside the home, her health visitors said it was shyness and told her not to be overly concerned. “Some made me feel like I was a pushy mother trying to turn Lauren into an outgoing child, and suggested that I should accept that she is shy.”
But Edem knew that it was more than shyness that prevented Lauren, now 5, from speaking at school or ballet and swimming lessons — indeed, any public place. This led to situations that ranged from inconvenientto downright distressing. “Lauren once went to a summer scheme and the play workers took the children to the toilets but forgot about her, because she was so quiet. They had left her and she was alone for more than 15 minutes. When they found her she was crying hysterically.”
Surely the terror of speaking can’t be as bad as the terror of being left alone? The fear can be akin to a phobia, says Maggie Johnson, a speech and language therapist for East Kent Coastal Teaching Primary Care Trust, and the co-author of The Selective Mutism Resource Manual. “Once they are talking, selectively mute children tell us they feel not only a general sense of panic, but also that the voice is actually shutting down, the muscles are clamping. One boy said he felt as if his head was going to explode. It can be a very physical sensation.”
After fruitless appointments with GPs and health visitors, who insisted that Lauren would grow out of the condition, Eddi heard about SM through Lauren’s Year 1 teacher, who organised a special-needs assessment. This led to regular appointments with a speech and language therapist, and the school appointed a language support assistant to help Lauren to communicate in the classroom, using a combination of writing boards and behavioural modification methods to ease her into speaking in class.
Although Lauren is benefiting from the extra help, experts agree that it is important for children with SM not to be given too much extra attention for being silent, as it reinforces the role of being the child who doesn’t speak.
Johnson says families often have to consult a variety of professionals in search of assessment and treatment. “Professionally, nobody ‘owns’ the problem; it is not routinely in the training of speech and language therapists, psychologists, GPs or teachers. But ultimately, it doesn’t matter who works with SM as long as someone does.”
For Hannah, 10, that someone was initially a dedicated teacher at an English school in Brussels. Hannah had become withdrawn between the ages of 6 and 7 and was referred to a psychologist. She “had a lovely time”, says her mother Jo, “but didn’t actually speak”. She also saw a counsellor in the school — but when the latter didn’t show up one day, Hannah sat outside her office, unable to tell anyone — and a psychiatrist, “who got her to speak through puppets, which was a big breakthrough, but she was still silent in class”.
Hannah’s teacher was determined to crack the problem, and agreed to meet the child and her mother regularly school. The idea was for Hannah to become comfortable enough to talk to her mother in the presence of the teacher, and then, gradually, to her teacher without her mother there. This technique, known technically as “stimulus fading”, is often used in conjunction with “shaping” — taking a slow, step-by-step approach to eliciting speech, perhaps starting with opening the mouth or making simple sounds.
Many teachers contact SMIRA (Selective Mutism Information and Research Association). But, says its chairwoman, Alice Sluckin, in a busy classroom, these children’s problems are “pushed under the carpet because they are no trouble compared with the hyperactive children, who might disrupt a whole class”. Sluckin, a retired psychiatric social worker, adds that many children with SM are also very bright, but it is hard for teachers to assess this when a child feels unable to speak.
Sometimes a child will spontaneously “recover”. Patricia Stills’s son Joseph was silent in class for most of his nursery education. “He could count to 50 at home, but at school they couldn’t find out if he could count to ten. He would not join in any activities or songs and, if he were forced to speak, would whisper.
“But I think he realised what he was missing. It took him longer still to speak to other adults outside the classroom setting, but he will do so now, though he is still shy and quiet.”
Unfortunately, recovery without intervention is rare once SM is firmly established. And it is “wrong” to rely on things improving without intervention, says Tony Cline, a professor of educational psychology at the University of Luton and co-author of Selective Mutism in Children. But it must be the right kind of intervention: “A common error is making inconsistent rewards, such as ‘If you speak to X, we will give you a present’. This doesn’t work, nor do punishment or threats. Another problem is people around the child reinforcing his/her identity as someone who doesn’t speak.”
SMIRA (0116 2127411), Tuesday, Wednesday and Friday, 4pm-7pm
